BMC Anesthesiology最新文献

{"title":"Pulse pressure versus continuous flow monitoring for fluid responsiveness prediction during passive leg raising: a prospective diagnostic accuracy study.","authors":"Fatemeh Monjazebi, Vahid Zamanzadeh, Mansoureh Ashoub, Babak Jahangirifard","doi":"10.1186/s12871-026-04072-8","DOIUrl":"10.1186/s12871-026-04072-8","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of fluid responsiveness is essential in managing circulatory shock. While passive leg raising (PLR) is recommended in international guidelines, its diagnostic validity depends critically on the monitoring modality used to detect hemodynamic responses. In resource-limited settings, manual blood pressure measurement remains the predominant available technology, yet its adequacy for PLR interpretation has not been rigorously evaluated in an adequately powered study with an independent reference standard.</p><p><strong>Objective: </strong>To compare the diagnostic accuracy of manual pulse pressure change (ΔPP%) versus continuous flow monitoring (USCOM-1 A, ΔSV%) for predicting fluid responsiveness during PLR in intensive care unit (ICU) patients with undifferentiated shock, using echocardiographic cardiac output assessment as an independent reference standard.</p><p><strong>Methods: </strong>Prospective single-center diagnostic accuracy study enrolling consecutive ICU patients with undifferentiated shock at Sina Educational and Medical Center, Tehran, Iran (2020-2021). A standardized PLR protocol was performed with simultaneous blinded measurements by three independent operators: manual blood pressure via calibrated sphygmomanometer, continuous flow monitoring via USCOM-1 A, and echocardiographic velocity-time integral (VTI) measurement as the reference standard. Fluid responsiveness was defined as ≥ 15% cardiac output increase following 500 mL crystalloid challenge. Primary outcome was area under the receiver operating characteristic curve (AUC). The study followed Standards for Reporting Diagnostic Accuracy Studies (STARD) 2015 guidelines (Ethics approval: IR.SBMU.PHARMACY.REC.1399.316).</p><p><strong>Results: </strong>Of 124 patients analyzed (mean age 58.1 ± 19.8 years, 65.3% female), 58 (46.8%) were fluid responders. Continuous flow monitoring demonstrated acceptable diagnostic accuracy (AUC 0.712, 95% confidence interval [CI] 0.622-0.802; sensitivity 81.0%; specificity 61.8%; negative predictive value [NPV] 79.2%). Manual pulse pressure demonstrated significantly inferior discrimination (AUC 0.601, 95%CI 0.502-0.700; DeLong test P = 0.029) with critically low sensitivity (32.8%) and clinically inadequate NPV (57.8%). Bootstrap-corrected performance estimates confirmed the robustness of findings (USCOM AUC 0.708; Manual pulse pressure [PP] AUC 0.596). Mean pulse pressure remained essentially unchanged during PLR (+ 0.4 ± 4.6 mmHg, P = 0.287) despite significant proportional increases in both systolic (+ 3.7%) and diastolic (+ 5.6%) pressures, and despite echocardiographically confirmed stroke volume augmentation (left ventricular outflow tract [LVOT] VTI + 15.9%). The correlation between ΔPP% and ΔSV% was weak (r = 0.39, R²=0.15). Baseline method comparison between USCOM-derived and echocardiography-derived cardiac output showed low paired bias, although the percentage error exceeded the conven","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sevoflurane blood concentrations in patients undergoing mild and moderate hypothermic cardiac surgery: a prospective observational study.","authors":"Takahiro Tamura, Atsushi Mori, Takahiro Imaizumi, Tatsuro Yokoyama, Kimitoshi Nishiwaki","doi":"10.1186/s12871-026-04053-x","DOIUrl":"10.1186/s12871-026-04053-x","url":null,"abstract":"<p><strong>Background: </strong>We aimed to clarify the changes in sevoflurane blood concentrations in cardiovascular surgeries with cardiopulmonary bypass (CPB) under mild to moderate hypothermia.</p><p><strong>Methods: </strong>In this single-center, prospective observational study, we included patients undergoing elective cardiac surgery with CPB under mild and moderate hypothermia using four types of oxygenators. Radial artery blood samples were collected at repeated time points, both before and during CPB. Simultaneously, bladder temperature was recorded. Sevoflurane blood concentration was measured using gas chromatography.</p><p><strong>Results: </strong>Sevoflurane blood concentrations gradually increased during general anesthesia induction via native lung ventilation. When using CPB under mild hypothermia, the concentration dropped sharply after switching to an oxygenator but then gradually increased and reached equilibrium. These changes were observed in all four oxygenators, with no significant differences among them. In moderate hypothermic surgeries, the bladder temperature gradually decreased during the pre-circulatory-arrest phase, and the sevoflurane blood concentration increased accordingly. As rewarming began after the distal aortic anastomosis, the bladder temperature gradually increased, and the sevoflurane blood concentration returned to levels observed during native lung ventilation. In total, 85 patients undergoing mild hypothermic cardiac surgery (SE, n = 21; LI, n = 21; TE, n = 22; ME, n = 21) and 25 patients undergoing moderate hypothermic cardiac surgery were analyzed. Using a linear mixed-effects model, bladder temperature was significantly associated with sevoflurane blood concentration in both mild hypothermia (β = - 5.90 μg/mL per °C; n = 73 patients, 1,123 observations; p < 0.001) and moderate hypothermia (β = - 2.11 μg/mL per °C; n = 25 patients, 378 observations; p < 0.001) cardiac surgery. No significant differences in sevoflurane blood concentrations were observed among the four oxygenator types.</p><p><strong>Conclusions: </strong>We demonstrated chronological changes in sevoflurane blood concentrations during mild and moderate hypothermic cardiac surgery, showing an inverse correlation with bladder temperature.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and preparedness for local anesthetic systemic toxicity among surgical clinicians: a multi-center cross-sectional survey study.","authors":"Rasim Onur Karaoglu, Acelya Toprak Karaoglu, Sezen Kumas Solak, Mehmet Salih Sevdi, Serdar Demirgan","doi":"10.1186/s12871-026-04073-7","DOIUrl":"10.1186/s12871-026-04073-7","url":null,"abstract":"<p><strong>Background: </strong>Local Anesthetic Systemic Toxicity (LAST) is a rare but potentially fatal complication of regional anesthesia and local anesthetic infiltration. Despite established treatment protocols, the extent of clinician awareness and institutional preparedness across surgical specialties remains poorly characterized.</p><p><strong>Methods: </strong>This descriptive cross-sectional study enrolled 192 physicians from eight surgical specialties across five tertiary-level training and research hospitals in Türkiye (April-May 2025). A validated, structured questionnaire assessed LAST knowledge, clinical practices, and institutional readiness. Multivariable logistic regression identified independent predictors of correct lipid emulsion dosing knowledge, adjusting for specialty, seniority, and training status.</p><p><strong>Results: </strong>Only 41.1% of participants had received formal LAST training. Correct identification of the recommended lipid emulsion bolus dose (1.5 mL/kg) was reported by 34.4% overall, rising to 58.2% among trained participants versus 18.1% among untrained participants (p < 0.001). On multivariable analysis, formal training (OR 6.38; 95% CI 3.21-12.68), anesthesiology specialty (OR 3.14; 95% CI 1.67-5.91), and senior academic title (OR 2.07; 95% CI 1.08-3.96) were independent predictors of correct dose knowledge. Early symptom recognition was reported by 49.5%. Aspiration before injection was performed consistently by 53.1%, and ultrasound guidance by 38.5%. Lipid emulsion was readily available in only 29.2% of departments.</p><p><strong>Conclusion: </strong>Significant gaps exist in LAST knowledge, preventive practices, and institutional preparedness across surgical specialties. Targeted simulation-based education, mandatory availability of lipid emulsion, and standardized institutional protocols are warranted to improve patient safety.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of end-tidal carbon dioxide as a surrogate for arterial carbon dioxide assessment in infants undergoing thoracoscopic surgery with one-lung ventilation.","authors":"Change Zhu, Sisi Wei, Rufang Zhang, Mazhong Zhang, Rong Wei","doi":"10.1186/s12871-026-04077-3","DOIUrl":"10.1186/s12871-026-04077-3","url":null,"abstract":"<p><strong>Background: </strong>The reliability of end-tidal carbon dioxide (EtCO₂) as a surrogate for arterial arterial carbon dioxide partial pressure (PaCO₂) during one-lung ventilation (OLV) in infants is uncertain. This study evaluated EtCO₂-PaCO₂ agreement in infants undergoing OLV and identified factors associated with clinically significant discrepancy.</p><p><strong>Methods: </strong>This secondary analysis of a prospective, randomized controlled trial included 172 infants (aged ≤ 2 years) undergoing thoracoscopic surgery. Paired PaCO₂ and EtCO₂ measurements were obtained 20 min after initiating OLV. Clinical agreement was defined a priori as an absolute difference of ≤ 5 mmHg. Statistical evaluations included Bland-Altman analysis and multivariable logistic regression to identify predictors of disagreement, and correlation analyses.</p><p><strong>Results: </strong>During OLV, the mean EtCO₂-PaCO₂ bias was 2.8 mmHg with wide 95% limits of agreement (-4.7 to 10.3 mmHg), exceeding the clinically acceptable threshold. Oxygenation impairment (PaO₂/FiO₂ < 200 mmHg) significantly reduced the proportion of clinically acceptable measurements (55.9% vs. 81.7%, P = 0.0001). In multivariable analysis, EtCO₂-PaCO₂ disagreement occurred exclusively in infants ventilated under the non-protective protocol (VT 8 mL/kg with ZEEP). After excluding ventilatory variables that were structurally confounded with randomized allocation, lower lung compliance was independently associated with disagreement (adjusted OR 1.66, 95% CI 1.05-2.64, P = 0.030).</p><p><strong>Conclusions: </strong>EtCO₂ provides only limited reliability as a stand-alone substitute for arterial blood gas analysis in infants during OLV, particularly under non-protective ventilation. The lung-protective ventilation strategy as a composite intervention is associated with substantially improved EtCO₂-PaCO₂ agreement during OLV in infants. Among individual patient-level factors, lower lung compliance independently predicts EtCO₂-PaCO₂ disagreement and may serve as a bedside indicator for clinicians to consider supplementary arterial blood gas analysis.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative anesthesia management for a child with congenital adrenal cortical hyperplasia undergoing thoracoscopic repair of atrial septal defect: a case report and literature review.","authors":"Jiao Wang, Shiqian He, Xiaoyi Pang, Weijie Zhang","doi":"10.1186/s12871-026-04071-9","DOIUrl":"10.1186/s12871-026-04071-9","url":null,"abstract":"<p><strong>Background: </strong>Congenital adrenal cortical hyperplasia (CAH) includes a group of autosomal recessive genetic disorders characterized by impaired synthesis of adrenal corticosteroid hormones. The clinical manifestations associated with CAH commonly include electrolyte imbalance, refractory hypotension, metabolic acidosis, hypoglycemia, and adrenal crisis. The coexistence of endocrine insufficiency and cardiopulmonary abnormalities complicates clinical management in children with CAH undergoing thoracoscopic atrial septal defect (ASD) repair for congenital heart disease. Although thoracoscopic procedures have advantages because of their minimally invasive nature, they also involve risks such as pneumothorax, low-tidal-volume ventilation, and postural changes, which may aggravate hemodynamic fluctuations. These factors considerably increase the difficulty of perioperative management and the risk of complications. Therefore, precise and individualized perioperative anesthesia management is essential. To maintain hemodynamic and respiratory function and ensure surgical safety, comprehensive preoperative assessment, standardized glucocorticoid stress replacement, optimized anesthesia strategies, advanced multi-dimensional monitoring, and careful maintenance of circulatory and internal environmental stability are required.</p><p><strong>Case presentation: </strong>This article describes a clinical case of a 21-month-old infant diagnosed with CAH complicated by ASD. After assessment by a multidisciplinary team (MDT), an individualized perioperative anesthesia strategy was developed and applied. Thoracoscopic ASD repair was successfully performed through comprehensive management, including preoperative correction of electrolyte imbalance, intraoperative hormone replacement therapy, continuous monitoring of the internal milieu and hemodynamic stability, and postoperative optimization of pain control and anti-infective therapy. No significant complications occurred during the perioperative period.</p><p><strong>Conclusion: </strong>Effective perioperative management should address insufficient and excessive secretion of adrenal cortical hormones, as well as the effects of long-term exogenous hormone therapy in children with CAH undergoing cardiac surgery. In addition, maintenance of endocrine homeostasis and hemodynamic stability is critical for reducing the risk of adverse events. This case further suggests that the clinical value of management lies in integrating endocrine preparation with cardiac anesthesia and postoperative surveillance, rather than in any single isolated intervention.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jet ventilation in severe airway stenosis: how pressure and frequency shape airway pressure and ventilation.","authors":"Mingyuan Yang, Zhuomin Deng, Hong Li, Jing Guo, Yuxue Yao, Shuwang Yang, Qinghao Cheng","doi":"10.1186/s12871-026-04075-5","DOIUrl":"10.1186/s12871-026-04075-5","url":null,"abstract":"<p><strong>Background: </strong>Jet ventilation is widely used during rigid bronchoscopy, particularly in patients with airway narrowing, yet evidence guiding the selection of driving pressure and frequency in severely narrowed airways remains limited.</p><p><strong>Objectives: </strong>To investigate how jet driving pressure and frequency interact with airway geometry to determine airway pressure, ventilation, and gas exchange during normal-frequency jet ventilation (NFJV) and high-frequency jet ventilation (HFJV) in normal and severely narrowed airways.</p><p><strong>Methods: </strong>Jet ventilation was applied to a 3D printed adult airway model under two conditions: a normal airway and a severely narrowed airway simulating 90% fixed circumferential stenosis. Airway pressure, tidal volume, intrinsic positive end-expiratory pressure (PEEP), inspiratory and expiratory flow rates, and oxygen concentration were measured.</p><p><strong>Results: </strong>Driving pressure was the primary determinant of airway pressure, tidal volume, and inspiratory flow under both ventilation modes. Under NFJV, airway pressure increased more steeply with pressure in the normal airway, whereas under HFJV, increasing pressure led to progressive pressure accumulation in the narrowed airway, resulting in higher airway pressures at elevated settings. Intrinsic PEEP was consistently higher in the narrowed airway and was amplified by increasing pressure and frequency. Across both modes, tidal volume decreased with increasing frequency and exhibited attenuated pressure responsiveness. Although measured oxygen concentration was higher in the narrowed airway, expiratory flow was markedly reduced, indicating impaired expiratory clearance.</p><p><strong>Conclusions: </strong>Severe airway narrowing fundamentally alters the pressure-frequency-ventilation relationship during jet ventilation. In narrowed airways, escalation of driving pressure or frequency may increase pressure load and intrinsic PEEP without proportionally improving effective ventilation. Optimization should therefore prioritize adequate tidal volume, expiratory emptying, and CO₂ monitoring rather than airway pressure or oxygen concentration alone.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferior vena cava respiratory variability changes during jet ventilation in rigid bronchoscopy: a prospective self-controlled study.","authors":"Mingyuan Yang, Yuxue Yao, Hong Li, Qinghao Cheng, Guyan Wang","doi":"10.1186/s12871-026-04059-5","DOIUrl":"10.1186/s12871-026-04059-5","url":null,"abstract":"<p><strong>Background: </strong>Inferior vena cava (IVC) respiratory variability is widely used to assess volume status and fluid responsiveness, but its interpretation depends on the physiological context. During rigid bronchoscopy, jet ventilation creates a distinct ventilatory environment, and its impact on IVC-derived indices remains unclear.</p><p><strong>Methods: </strong>This prospective self-controlled observational study included 60 adult patients undergoing rigid bronchoscopy under general anesthesia. Measurements were obtained at three predefined time points: awake baseline (T0), mask-assisted positive-pressure ventilation during induction (T1), and stable intraoperative jet ventilation (T2). IVC parameters were assessed using M-mode ultrasonography. The primary outcome was the paired change in IVC distensibility index (dIVC) between T1 and T2.</p><p><strong>Results: </strong>dIVC decreased significantly from T1 to T2 (86.29 ± 35.09% vs. 22.08 ± 12.86%, P < 0.001). The mean paired change (ΔdIVC) was - 64.22 ± 35.84%, corresponding to a large effect size (Cohen's d = 1.79). This change was accompanied by an increase in IVCmin and a reduction in absolute IVC diameter variation. In contrast, heart rate and mean arterial pressure remained stable.</p><p><strong>Conclusions: </strong>IVC-derived respiratory variability changed markedly after transition from mask-assisted positive-pressure ventilation to open jet ventilation during rigid bronchoscopy. This observation suggests that IVC-derived indices are sensitive to ventilation mode and airway openness, and should not be interpreted as direct evidence of intravascular volume status or fluid responsiveness in this setting. Conventional IVC thresholds derived from spontaneous breathing or closed positive-pressure ventilation should therefore be applied with caution during open jet ventilation.</p><p><strong>Trial registration: </strong>This study was registered in the Chinese Clinical Trial Registry on March 24, 2026 (ChiCTR2600121550).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing and validating an interpretable machine learning model for predicting postoperative nausea and vomiting in pulmonary resection patients: a retrospective observational study.","authors":"Zhensheng Huang, Shu Wang, Yahong Liu, Lan Lan, Yunpeng Li, Xiaolin Luo, Xiaofei Lv, Weiqiang Zhong, Jingdun Xie","doi":"10.1186/s12871-026-03942-5","DOIUrl":"https://doi.org/10.1186/s12871-026-03942-5","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) remains a prevalent complication hindering Enhanced Recovery After Surgery (ERAS) protocols, particularly after pulmonary resection. While established clinical risk factors exist, the Apfel score lacks precision for individualized prediction and ignores neuroanatomical biomarkers. This study aimed to develop and validate an interpretable machine learning (ML) model integrating clinical variables and structural brain MRI features to predict PONV risk.</p><p><strong>Methods: </strong>In this retrospective study, 416 patients undergoing pulmonary resection were analyzed. Preoperative T1-weighted MRI and 19 perioperative clinical variables were collected. A total of 1,174 structural brain features were extracted using FreeSurfer. Feature engineering included handling missing data, univariate screening, bootstrap-enhanced LASSO for stable feature selection, and forced retention of key clinical factors. The final feature subset was optimized. Eleven ML models were trained and hyperparameters tuned. Model performance was evaluated via internal and external validation.</p><p><strong>Result: </strong>The optimal model (ExtraTrees classifier) achieved an AUROC of 0.82 on internal validation cohort and 0.80 on external validation cohort, significantly outperforming the Apfel score. Key predictive features included female sex, reduced left parieto-occipital cortical curvature, and decreased right occipital pole curvature/cuneus folding index. SHAP analysis confirmed these neuroanatomical features, alongside clinical factors, as primary drivers of individual predictions.</p><p><strong>Conclusions: </strong>This study demonstrates that integrating structural neuroimaging biomarkers with clinical data significantly enhances PONV prediction after lung surgery compared to traditional models. The identified neuroanatomical features, particularly in visual and vestibular processing regions, provide novel biological insights into PONV susceptibility. Our interpretable ML model offers a promising tool for personalized PONV risk stratification, potentially guiding targeted prophylaxis within ERAS pathways. Validation in larger, prospective cohorts is warranted.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence assisted telemedicine, clinical decision support for anesthesia and critical care in intensive care units: a scoping review.","authors":"Qingxia Yang, Meixia Li, Yu Lei","doi":"10.1186/s12871-026-03997-4","DOIUrl":"10.1186/s12871-026-03997-4","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has been increasingly used in care delivery in intensive care units (ICUs) and anesthesia-critical care practice through telemedicine, tele-ICU systems, and remote patient monitoring, and is expected to support real-time clinical decision-making.</p><p><strong>Methods: </strong>This scoping review followed PRISMA-ScR guidelines to map the existing evidence of AI in critical care and anesthesia-related ICU environments for telemedicine, telemonitoring, and clinical decision support systems. PubMed, Scopus, and Google Scholar were used to search for relevant literature, including the use of AI, telemedicine, predictive analytics, remote monitoring, and anesthesia-informed clinical decision support in critical care.</p><p><strong>Results: </strong>The literature reviewed primarily focused on the non-generative AI solutions, such as machine learning, deep learning-based monitoring, and AI clinical decision support systems. Such systems can facilitate remote continuous monitoring, early detection of clinical deterioration, and clinical decision-making in the ICU perioperative anesthesia-critical care settings. The results were grouped into the following categories: tele-ICU implementation, predictive analytics, tele-monitoring, and AI-guided clinical decision support. The reported benefits included better monitoring, improved workflow, enhanced anesthesia and critical care decision-making, and greater access to specialist care, but there was substantial variation in the evidence of consistent improvement in patient-centered outcomes, with most of it being observational. Data quality, interoperability, model transparency, ethical issues, and lack of prospective clinical validation were the key difficulties encountered.</p><p><strong>Conclusion: </strong>AI-enabled telemedicine remains a nascent healthcare space in the ICU and anesthesia-critical care continuum, and further standardization, validation, and prospective clinical testing are needed to ensure its safe and scalable integration into clinical practice.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative corticosteroid practices in otorhinolaryngologic surgery: decision-making, autonomy conflicts, and defensive attitudes among anesthesiologists in Turkey: a multicenter cross-sectional survey study.","authors":"Cengizhan Yavuz","doi":"10.1186/s12871-026-04062-w","DOIUrl":"10.1186/s12871-026-04062-w","url":null,"abstract":"<p><strong>Objective: </strong>Despite strong evidence supporting the use of perioperative corticosteroids in otorhinolaryngologic (ENT) surgery, significant heterogeneity exists in clinical practice. This study aimed to evaluate the indications, agent/dosage preferences, autonomy in decision-making processes, and defensive medical attitudes regarding potential complications of corticosteroid use among anesthesiologists in Turkey.</p><p><strong>Materials and methods: </strong>This multicenter, cross-sectional, web-based survey included 158 anesthesiologists working in various healthcare institutions. Participants' steroid prescribing habits, pharmacological preferences, interdisciplinary decision-making dynamics across eight different ENT procedures, and concerns regarding complications (bleeding, wound healing, hyperglycemia, infection) were investigated. Furthermore, clinical management approaches were evaluated using a scenario involving a well-controlled diabetic patient.</p><p><strong>Results: </strong>The most frequently reported indication for corticosteroid use was the prevention of airway edema (90.5%), and the most preferred regimen was 1 mg/kg methylprednisolone (68.4%). The procedures with the highest rates of autonomous steroid administration by anesthesiologists without consulting the surgeon were adenotonsillectomy (73.4%) and microlaryngeal surgery (65.8%). Participants' concern scores for postoperative hyperglycemia were significantly higher than those for bleeding (mean 2.80 vs. 1.84; p < 0.001). In a scenario involving a well-regulated diabetic patient, only 42.4% of the physicians stated they would continue the standard dose with intensified blood glucose monitoring, whereas the remaining majority (57.6%) exhibited pronounced defensive approaches, such as reducing the dose, withholding it entirely, or reserving it exclusively for critical airway emergencies (46.2%).</p><p><strong>Conclusion: </strong>Although corticosteroid practices among Turkish anesthesiologists in ENT surgery are generally consistent with current literature, defensive attitudes stemming from the fear of postoperative hyperglycemia lead to medically unjustified, suboptimal treatment approaches in diabetic patients. The uncertainties in interdisciplinary decision-making processes and the unnecessary reliance on surgical approval highlight a critical need for institutional, evidence-based perioperative management protocols developed collaboratively by anesthesiology and ENT specialty societies.</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}